New JCAHO Standards Bolster PAs in Hospitals

From AAPA News, July 30, 2003

By Sharon Kulesz, PA-C

There is good news on the horizon for PAs who work in hospitals. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has revised its hospital standards and made important changes that address privileging PAs through the medical staff or an equivalent process, recognize federal PAs in the credentialing standards, and broaden the requirements for medical staff membership. The new standards go into effect in January 2004.

Privileges for PAs

Hard work and persistence by three PAs on JCAHO’s Hospital Standards Committee has raised the level of understanding of PA practice among JCAHO leaders. As a result, the new overview to the medical staff standards explicitly recognizes the importance of privileging PAs. It states: “Physician assistants (PAs) and advanced practice nurses (APNs) who are not LIPs [licensed independent practitioners] may be privileged through the medical staff process or a process that has been developed and approved by the organization that is equivalent to the process and criteria set forth in the credentialing and privileging standards contained in this chapter.” While AAPA intends to push for more exclusive language that will require privileging of PAs through the medical staff only, this is a step in the right direction.


AAPA’s representatives to JCAHO —Trish Marriott, Bill Cimbalik, and Sharon Kulesz —educated and negotiated through many circular discussions and changes of direction as stakeholders hammered out the new standards in the Comprehensive Accreditation Manual for Hospitals. Hopes of eliminating the terminology “licensed independent practitioner” were dashed, but discussions around that point led to better understanding of the PA role and how physician-PA teams function in hospitals.

Federal PAs Recognized

The AAPA team was able to negotiate an important clause for federally employed PAs. JCAHO credentialing requirements, which include licensure, have created practice difficulties for some federally employed PAs, who typically are not licensed but practice under federally established criteria. A new statement in the rationale for standard MS.4.10 says, “Physician assistants in federal service use criteria established by federal standards.” The remaining criteria — relevant training or experience, current competence, and ability to perform privileges— are easily met by federal PAs.

Medical Staff Membership Standard

JCAHO leaders demonstrated their understanding of changes in the delivery of health care and composition of hospital medical staffs by broadening the medical staff membership standard. The current version of the medical staff membership standard uses language that is often misinterpreted to imply that only practitioners who practice independently in the hospital are eligible for medical staff membership. AAPA provided JCAHO with data collected from more than 100 PAs that show that many of the hospitals where PAs work include PAs on the medical staff. This data was also supported by reports from a representative from the National Association of Medical Staff Services.


The overview of the medical staff chapter recognizes the changes of the composition of the modern medical staff by stating that: “The governing body and the medical staff define medical staff membership criteria that must include LIPs but may include other practitioners as deemed necessary by the governing body and the medical staff. The Joint Commission does not dictate who is eligible for medical staff membership at accredited hospitals.” This change makes it clear that PAs may be part of the medical staff if the hospital wishes to include them.


These landmark changes represent significant progress in the relationship between AAPA and JCAHO. AAPA staff and representatives continue to work closely with JCAHO leaders to ensure that accreditation standards include PAs and do not create barriers for PA practice.

The revised 2004 Joint Commission prepublication standards are posted on the JCAHO Web site, www.jcaho.org. For further information on the standards or other JCAHO matters, contact Sharon Kulesz, AAPA assistant director, professional affairs, skulesz@aapa.org; 703/836-2272, ext. 3221.

 

Last Revised: 4/7/04